Fecal incontinence: challenges in electrodiagnosis and rehabilitation

BackgroundPelvic floor disorders are a common, yet debatable medical challenge. The management of fecal incontinence (FI) has always been a puzzle as it is a multifactorial problem that needs a skilled specialized teamwork.Main body of abstractFI has complex etiology including altered rectal sensibility, dysfunction of the pelvic floor muscles, and damage to the anal sphincter complex. The most valuable tests for the evaluation of FI are anorectal manometry, endoanal ultrasound, MRI with or without defecography, and neurophysiological studies. Neurophysiological tests of the pelvic floor muscles represent a valid method for studying the functional integrity of neural pathways, localizing a pathological process, and possibly revealing its mechanism and severity. These tests include assessment of conduction of the pudendal nerve, electromyography (EMG) of the sphincter as well as pelvic floor muscles, sacral reflexes, somatosensory-/motor-evoked responses, and perineal sympathetic skin response. Different approaches are available for the treatment of FI. These include conservative measures such as lifestyle and dietary modifications, medications, and pelvic floor rehabilitation which are considered the preferred lines to avoid the risk of interventions. However, more invasive approaches as the use of perianal injectable bulking agents, sacral nerve stimulation, or surgery are also present.ConclusionFinally, management of FI is a true challenge that needs multidisciplinary approach. Integrated diagnostic work-up between the related subspecialities, as well as tailoring the management plan according to each case, would help to reach best outcome.